Precious Moments - September 23-25, 2020 · 2020-04-08 · Dear Precious Moments Family, Such...

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UPDATE: Missouri issued a Stay At Home order that is in effect April 6 – April 24. In light of this information, we have made the decision to move the 2020 Precious Moments Family Reunion Event to September 23-25, 2020 Registration deadline has been extended to May 29, 2020. We hope you will join us for the 2020 Precious Moments Family Reunion Event later this year. Please contact our Event Hotline (417-359-2955) for any questions. Due to the current global crisis, kindly note our Event Hotline staff is limited. Responses to messages left on the Event Hotline may be delayed. Return your completed Registration Form, Order Form, Payment Form, and payment by the new Early Bird Registration deadline May 29, 2020 to guarantee all your Full Packet goodies: Precious Moments Foundation Attn: Reunion Event 2020 U.S. MAIL: 4321 Chapel Road FAX: 417-359-2939 (credit card payment only) Carthage, Missouri 64836 U.S.A. EMAIL: [email protected] (credit card payment only) Every effort has been made to guarantee the accuracy of the information in these documents, however, in some instances actual times, dates, VIPs, product availability, and locations may vary from this publication. Neither Precious Moments Foundation nor Precious Moments Family of Companies, Inc. can be responsible for errors, delays, changes made by or actions of Precious Moments Foundation, Precious Moments Family of Companies, Inc., or any customer/attendee, or any third-party provider, including any losses, damages, or harm suffered as a result of cancellation, scheduling/itinerary changes, weather-related conditions, and/or acts of God.

Transcript of Precious Moments - September 23-25, 2020 · 2020-04-08 · Dear Precious Moments Family, Such...

Page 1: Precious Moments - September 23-25, 2020 · 2020-04-08 · Dear Precious Moments Family, Such excitement and joy fills our hearts upon sending this invitation to you! Please join

UPDATE: Missouri issued a Stay At Home order that is in effect April 6 – April 24. In light of this information, we have made the decision to move the 2020 Precious Moments Family Reunion Event to

September 23-25, 2020 Registration deadline has been extended to May 29, 2020.

We hope you will join us for the 2020 Precious Moments Family Reunion Event later this year. Please contact our Event Hotline (417-359-2955) for any questions. Due to the current global crisis, kindly note our Event Hotline staff is limited. Responses to messages left on the Event Hotline may be delayed.

Return your completed Registration Form, Order Form, Payment Form, and payment by the new Early Bird Registration deadline May 29, 2020 to guarantee all your Full Packet goodies:

Precious Moments Foundation

Attn: Reunion Event 2020 U.S. MAIL: 4321 Chapel Road FAX: 417-359-2939 (credit card payment only) Carthage, Missouri 64836 U.S.A. EMAIL: [email protected] (credit card payment only) Every effort has been made to guarantee the accuracy of the information in these documents, however, in some instances actual times, dates, VIPs, product availability, and locations may vary from this publication. Neither Precious Moments Foundation nor Precious Moments Family of Companies, Inc. can be responsible for errors, delays, changes made by or actions of Precious Moments Foundation, Precious Moments Family of Companies, Inc., or any customer/attendee, or any third-party provider, including any losses, damages, or harm suffered as a result of cancellation, scheduling/itinerary changes, weather-related conditions, and/or acts of God.

Page 2: Precious Moments - September 23-25, 2020 · 2020-04-08 · Dear Precious Moments Family, Such excitement and joy fills our hearts upon sending this invitation to you! Please join

For your convenience, the 2020 Family Reunion Event Registration Packet is available to you in multiple formats. *PAPER FORM: if you attended a Family Reunion Event in the past 2 years, and did not previously provide an email address, we mailed a paper form to the address listed on your prior registration. *DIGITAL / CLICKABLE: this clickable PDF can be completed using the auto-fill options. If you are experiencing issues downloading or using this clickable PDF, you may need to download and run the Adobe Reader plugin.

Open Internet Explorer, choose Tools > Manage Add-ons

Select Add-on Types, choose Toolbars > Extensions > Show Menu

Choose All Add-ons, select Adobe PDF Reader

Click Enable

Open Chrome, choose Menu > More Tools > Extensions

Enable Adobe Acrobat extension

Microsoft Edge does not support any ActiveX plug-ins. Please change default browser setting to Internet Explorer or Chrome.

In Finder, select the PDF, choose File > Get Info

Choose Open With Menu, choose Adobe Acrobat or Adobe Acrobat Reader

Click Change All > Continue *DIGITAL / NON-CLICKABLE: If you are experiencing issues with the digital/clickable PDF, visit www.PreciousMoments.com/content/2020FamilyReunionRegistrationPacket-Download.pdf to download a digital PDF to complete without using the auto-fill options.

Return your completed Registration Form, Order Form, Payment Form, and payment:

Precious Moments Foundation

Attn: Reunion Event 2020 U.S. MAIL: 4321 Chapel Road FAX: 417-359-2939 (credit card payment only) Carthage, Missouri 64836 U.S.A. EMAIL: [email protected] (credit card payment only)

Internet Explorer

Chrome

Microsoft Edge

Safari

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Dear Precious Moments Family,

Such excitement and joy fills our hearts upon sending this invitation to you! Please join us for the one and only 2020 Precious Moments Chapel Family Reunion Event. This year’s Event has been rescheduled for September 23-25, 2020.

What is in store for this year? First, an Event theme perfect for the world in which we live, With God We Can Do It! This theme is not only universally applicable it reflects a deep and abiding personal belief of Sam Butcher and the Precious Moments Foundation team. For the heart of Precious Moments Family Reunion Event is God’s love for us and, in turn, our love for each other. The theme is also historically accurate. Throughout the years, our Precious Moments family members have shared the gift of love in so many ways. Whether it has been acts of loving in times of celebration, acts of caring to help those less fortunate, or acts of sharing through a thoughtful card or a warm hug, you have made a real and important difference. To express our gratitude for your countless acts of thoughtfulness, kindness, and compassion, this Event theme was chosen especially to encourage, inspire, and celebrate your continued love walk.

Through our eyes, you exemplify the spirit of the 2020 Event Exclusive figurine. Our darling retro Precious Moments girl is ready for whatever life unfolds. Wearing work clothes and a polka dot scarf, she flexes her strong right arm to exhibit “I can do all this”. Her companion, a tiny mouse, holds a cross as a reminder that even in the smallest of details, hope comes “from Him who gives us strength.” Philippians 4:13

With us during this year’s Event will be many of your favorite Precious Moments VIPs including Hiko Maeda, Willamae, Larry Turner and Friends, plus special entertainment, and one of our newest Precious Moments friends, Matthew Milliner, Ph.D. has planned an exciting new presentation.

Unfortunately, our timeline will not allow for an extension of deadlines this year. Registration documents must be returned promptly. What are you waiting for? Call your friends and plan a road trip to your home away from home, the Precious Moments Chapel.

Blessings to you and those you love,

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2020 REGISTRATION GUIDELINES

IMPORTANT: Registrations must be submitted no later than May 29, 2020 to guarantee Full Packet benefits!

REGISTRATION PACKET PRICING AND DEADLINES:

Registration forms must be received by the date listed. Postmarked dates will not qualify for deadlines. View a digital version of this packet: www.PreciousMoments.com/content/2020FamilyReunionRegistrationPacket.pdf

REFUND POLICY: Unfortunately, due to financial commitments, all registration fees, class fees, and payments are non-refundable. We apologize for any inconvenience this causes.

FIRST REGISTERED – FIRST SERVED POLICY: Activity passes, including signing events are assigned in the same order that registrations are received. Register early to secure an early signing event pass! Please plan your schedules and transportation accordingly.

REGISTERING AS A GROUP: Registrations are processed on a daily basis, and as such, space cannot be held for unregistered attendees. Avoid any disappointment by submitting all group reservations together, at the same time. In the instance additional parties are added to a group reservation, the registration date of all parties in the group will be moved to the date of the last person registering. NEW for 2020, contact information is required for all adult guests registering in a group.

ON-SITE REGISTRATION: On-Site Event Registration begins Tuesday, September 22 12:00pm – 5:00pm, continuing through Wednesday, September 23until 4:30pm at Fairview Christian Church.

Attendees arriving after 4:30pm on Wednesday, September 23 must pick-up their On-Site Registration Packet at the Precious Moments Visitor Center.

GIFT SHOPPE SALES:

During the Event, the ONLY way to take advantage of special offers is to show your Event badge at the cash register. Shopping times will be assigned to help avoid long lines and conflict with other activities. Please be respectful of this schedule, it is established to ensure all attendees enjoy a pleasurable shopping experience. Your assigned time will be in your On-Site Registration packet. All Event-exclusive items, including signed figurines and the Event figurine, will be available on a first-come first-served basis, while supplies last. Don’t miss out! Pre-order extra Event pins and Event tote bags. See details on the Registration Order Form in this packet.

MEN’S CHOIR: If you, or your guest, wish to participate in the Men’s Choir, it is important to check the box provided on the Registration Form. A minimum of 10 participants is required for the Choir to perform.

PAID CLASSES: Each year Event attendees are invited to participate in paid classes, allowing free expression of creativity and love of Precious Moments. Along with the fellowship and fun included in the classes, participants take home a very special, personal keepsake, sure to provide a lasting reminder of the Event. When determining class fees, the Precious Moments Foundation carefully considers all associated fees, including supplies and compensating instructors for time and efforts to develop, plan, and lead the activity. While it is our goal to keep class fees to a minimum, it is often necessary to fluctuate pricing due to economic changes out of our control. Participation in paid classes is optional. We hope you enjoy each class you experience.

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GOODIE BAGS AND EVENT T-SHIRTS: Extra t-shirts and other Goodie Bag items will not be available after May 30. Guarantee your t-shirt by submitting your Full Packet pre-registration for receipt by May 29.

GRAB BAGS: Grab Bags are available! Quantities are limited. First available purchase is at the Gift Shoppe beginning Wednesday, September 23. Specific details will be provided on the Schedule of Activities provided during On-Site Registration. Grab Bags will be available for purchase throughout the Event, while supplies last.

SHIPPING POLICY:

If you are unable to attend and would like your Goodie Bag shipped, payment of shipping costs is required prior to shipment. Late registrants who attend and are unable to pick-up additional Event merchandise at the Gift Shoppe are required to pay shipping costs prior to shipment, if such items are available.

GUEST BEHAVIOR:

This is a wholesome family event. Behavior that maintains the spirt of traditional family values is required. Each adult attendee (18 years and older) must sign the Registration Form. By signing, it is agreed that you will at all times support and adhere to the behavior policy and agree to the terms and conditions of the Guest Behavior and Attendance Policies published at www.PreciousMoments.com/event-policy.

LET THE GAMES BEGIN:

Bingo is one of our most popular games, offering loads of fun, fellowship, and prizes! Each year we strive to provide the very best bingo experience for our attendees. Join us during your pre-assigned bingo session for special treats and prizes!

Winners age 4 and younger will receive a very special prize! When a successful “bingo” is called, the winner will exchange their card with a staff member for a new

card and the game will reset. Attendees purchasing a Full, Guest, or Youth Packet are guaranteed one prize!

A TASTE OF ITALY MEAL VOUCHER: Each Packet contains one meal voucher redeemable at Taste Of Italy. Full, Guest, and Youth Packets = $10.00 voucher; Activities Packet (age 4 and under) = $5.00 voucher. Add-on selections, gratuity, and sales tax not included in voucher price. Check your On-Site Registration packet for more details. LODGING INFORMATION: This information is provided as a courtesy only. Limited space is available. Please contact your desired hotel early.

Carthage Convention and Visitor Bureau Joplin Convention and Visitor Bureau

866-357-8687 800-657-2534 visit-carthage.com joplincvb.com

EVENT HOTLINE: For more information or questions about the 2020 Precious Moments Family Reunion Event, please contact our Event Hotline (417-359-2855). Sorry, phone reservations will not be accepted.

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Tuesday, September 22:

12:00pm – 5:00pm On-Site Registration and Secondary Market Dealers

Fairview Christian Church

Wednesday, September 23:

9:00am – 5:00pm

4:30pm

On-Site Registration, Fundraising, Secondary Market,

Pre-Registered Classes (sessions 1 & 2 Make-A-Doll

and Crafty Workshop)

Fairview Christian Church

On-Site Registration closes at Fairview Christian

Church (Reopens at Precious Moments Visitor Center

at 5:30pm)

(Classes are pre-scheduled and must

be pre-paid)

9:30am – 8:00pm Grab Bags for Sale and Gift Shoppe special offers

Live and Silent Auction on Display (Silent Auction

bidding opens at 5:30pm)

Precious Moments Visitor Center

3:00pm – 4:15pm Opening Ceremony, Programming and

Mold Breaking

Fairview Christian Church

5:30pm – 7:45pm On-Site Registration

Precious Moments Visitor Center

6:00pm – 8:00pm VIP Meet and Greet/Icebreaker, Open Signings,

Special Offers, and so much more.

Precious Moments Visitor Center

(Open signings are in addition to

assigned signing times on Thursday

and Friday.)

8:00pm Precious Moments Visitor Center closes

Thursday, September 24:

8:30am – 12:00pm

9:00am – 12:00pm

Fundraising, Secondary Market Dealers open

Fairview Christian Church

Programming

Including PMC, What’s New!

9:30am – 5:30pm

Fairview Christian Church

On-Site Registration, Silent Auction bidding and Grab

Bag Sales

Precious Moments Visitor Center

12:30pm – 5:00pm

Shopping (with special offers!), Signing Event and

additional activities. Live and Silent Auction on

Display (Silent Auction bidding open until 4:45pm)

Precious Moments Visitor Center

(Signing sessions & Shopping pre-

scheduled)

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Thursday, September 24 :

4:45pm Silent Auction closes

Precious Moments Visitor Center

6:00pm Live Auction and Willa Mae Performance

Fairview Christian Church

Friday, September 25:

8:30am – 12:00pm Fundraising, Secondary Market Dealers open

Fairview Christian Church

9:00am – 12:00pm Programming

Fairview Christian Church

12:30pm – 4:30pm Shopping (with special offers!), Signing Event and

additional activities.

Precious Moments Visitor Center

(Signing sessions & Shopping pre-

scheduled)

3:00pm – 4:00pm Shipping Service by Precious Moments Co., Inc.

Precious Moments South Warehouse

6:00pm – 7:30pm Closing Ceremony and Entertainment (including

Donation Ceremony, Men’s Choir performance)

Fairview Christian Church

Saturday, September 26:

8:30am – 9:00am Inspirational Devotional

Precious Moments Chapel

Special Note:

Schedule subject to change without notice. Schedules provided during Event supersede all other published schedules.

Scheduling of Men’s Choir practices, Event Group Photo, “Precious Moments With Our Friends” Group Photo and Celebration of

Life will be confirmed in the schedule of activities included in the Confirmation Packet and On-Site Registration Packet.

Activities Are Scheduled To Take Place At The Following Locations: Precious Moments Visitor Center | 4321 Chapel Road, Carthage, MO 64836 | 417-359-7599

Fairview Christian Church | 2320 Grand Avenue, Carthage, MO 64836 | 417-358-3912

Page 9: Precious Moments - September 23-25, 2020 · 2020-04-08 · Dear Precious Moments Family, Such excitement and joy fills our hearts upon sending this invitation to you! Please join

REGISTRATION FORM

Please complete a Registration Form for each attendee registering in your group. Return completed Registration Form(s), Order Form, and full payment to Precious Moments Foundation.

The date the completed Registration Form, Order Form, and payment are received by Precious Moments Foundation determines the fee. All fees are non-refundable. Arrival times provided on this form and the order in which your registration is received by Precious Moments Foundation will determine pre-scheduled registration times for the Event. Completion of arrival date and time is required. Email completed Registration Form, Order Form, and Payment Form to [email protected].

Please note incomplete Registration Form(s) will not be processed and will be returned to the Main Registrant for completion.

MAIN REGISTRANT (Group Contact):

Name:

Age:

Address:

Men’s Choir Participant: Yes

City:

State: Zip:

Phone: ( ) Email:

Arriving in Carthage Date: Time: Departing:

Traveling with:

Choose Packet type:

Sorry, some Full Packet goodies are no longer available.

See Price List for detailed description of each Packet.

Full Guest Youth Activities (4 & under)

Select Add-On Paid Class(es)*: Make-A-Doll Crafty Workshop Signature Required: By signing this form, I verify I am at least 18 years old and authorize my registration for the 2020 Family Reunion Event. I understand that all registrations are final and all fees paid are non-refundable. I acknowledge receipt of and agree to the policies of Precious Moments Foundation, including the On-Site Behavior Policy (www.PreciousMoments.com/content/OnSiteBehaviorPolicy.pdf) for myself and for my minor child(ren) during the 2020 Family Reunion Event.

*All paid classes are limited to available space. First registered, first served.

Comments:

Page 10: Precious Moments - September 23-25, 2020 · 2020-04-08 · Dear Precious Moments Family, Such excitement and joy fills our hearts upon sending this invitation to you! Please join

REGISTRANT #2:

Name:

Age:

Address:

Men’s Choir Participant: Yes

City:

State: Zip:

Phone: ( ) Email:

Choose Packet type:

Sorry, some Full Packet goodies are no longer available. See Price List for detailed description of each Packet.

Full Guest Youth Activities (4 & under)

Select Add-On Paid Class(es)*: Make-A-Doll Crafty Workshop

Signature Required: By signing this form, I verify I am at least 18 years old and authorize my registration for the 2020 Family Reunion Event. I understand that all registrations are final and all fees paid are non-refundable. I acknowledge receipt of and agree to the policies of Precious Moments Foundation, including the On-Site Behavior Policy (www.PreciousMoments.com/content/OnSiteBehaviorPolicy.pdf) for myself and for my minor child(ren) during the 2020 Family Reunion Event.

Comments:

REGISTRANT #3:

Name:

Age:

Address:

Men’s Choir Participant: Yes

City:

State: Zip:

Phone: ( ) Email:

Choose Packet type:

Sorry, some Full Packet goodies are no longer available.

See Price List for detailed description of each Packet.

Full Guest Youth Activities (4 & under)

Select Add-On Paid Class(es)*: Make-A-Doll Crafty Workshop

Signature Required: By signing this form, I verify I am at least 18 years old and authorize my registration for the 2020 Family Reunion Event. I understand that all registrations are final and all fees paid are non-refundable. I acknowledge receipt of and agree to the policies of Precious Moments Foundation, including the On-Site Behavior Policy (www.PreciousMoments.com/content/OnSiteBehaviorPolicy.pdf) for myself and for my minor child(ren) during the 2020 Family Reunion Event.

Comments:

*All paid classes are limited to available space. First registered, first served.

Page 11: Precious Moments - September 23-25, 2020 · 2020-04-08 · Dear Precious Moments Family, Such excitement and joy fills our hearts upon sending this invitation to you! Please join

REGISTRANT #4:

Name:

Age:

Address:

Men’s Choir Participant: Yes

City:

State: Zip:

Phone: ( ) Email:

Choose Packet type:

Sorry, some Full Packet goodies are no longer available. See Price List for detailed description of each Packet.

Full Guest Youth Activities (4 & under)

Select Add-On Paid Class(es)*: Make-A-Doll Crafty Workshop

Signature Required: By signing this form, I verify I am at least 18 years old and authorize my registration for the 2020 Family Reunion Event. I understand that all registrations are final and all fees paid are non-refundable. I acknowledge receipt of and agree to the policies of Precious Moments Foundation, including the On-Site Behavior Policy (www.PreciousMoments.com/content/OnSiteBehaviorPolicy.pdf) for myself and for my minor child(ren) during the 2020 Family Reunion Event.

Comments:

REGISTRANT #5:

Name:

Age:

Address:

Men’s Choir Participant: Yes

City:

State: Zip:

Phone: ( ) Email:

Choose Packet type:

Sorry, some Full Packet goodies are no longer available.

See Price List for detailed description of each Packet.

Full Guest Youth Activities (4 & under)

Select Add-On Paid Class(es)*: Make-A-Doll Crafty Workshop

Signature Required: By signing this form, I verify I am at least 18 years old and authorize my registration for the 2020 Family Reunion Event. I understand that all registrations are final and all fees paid are non-refundable. I acknowledge receipt of and agree to the policies of Precious Moments Foundation, including the On-Site Behavior Policy (www.PreciousMoments.com/content/OnSiteBehaviorPolicy.pdf) for myself and for my minor child(ren) during the 2020 Family Reunion Event.

Comments:

*All paid classes are limited to available space. First registered, first served.

Page 12: Precious Moments - September 23-25, 2020 · 2020-04-08 · Dear Precious Moments Family, Such excitement and joy fills our hearts upon sending this invitation to you! Please join

PRICE LIST & ORDER FORM Please note: To be guaranteed Event benefits, registration and payment MUST be received by Precious Moments Foundation by May 29, 2020. Space, seating, and other goodies are limited and not guaranteed with late registrations. Event extras (t-shirts, pins, totes) will not be available for registrants after May 29. Email completed Registration Form, Order Form, and Payment Form to [email protected].

Confirm Packet selections below.

DESCRIPTION

QUANTITY

AMOUNT DUE Received by 5/29/2020

AMOUNT DUE Received 5/30/2020 – 8/1/2019

TOTAL

PACKETS FULL PACKET Includes: Event Figurine, Event T-Shirt (select size on Registration Form), Event Tote, Event Pin, Signing Pass, Bingo Prize, $10.00 Meal Voucher, Transportation Pass, Creative Activity, Entertainment

X $225.00 EACH $250.00 EACHǂ

(No shirt, tote, pin) $

GUEST PACKET Includes: Event Pin, Signing Pass, Bingo Prize, $10.00 Meal Voucher, Transportation Pass, Creative Activity, Entertainment

X $120.00 EACH $145.00 EACHǂ

(No pin) $

YOUTH PACKET (AGES 5-17) Includes: Event Pin, Youth Gift, Signing Pass, Bingo Prize, $10.00 Meal Voucher, Transportation Pass, Creative Activity, Entertainment

X $50.00 EACH $75.00 EACHǂ

(No pin) $

ACTIVITIES PACKET (AGES 4 AND UNDER ONLY) Includes: Signing Pass, Bingo Prize, $5.00 Meal Voucher, Transportation Pass, Entertainment

X FREE FREE $

00.00

Page 13: Precious Moments - September 23-25, 2020 · 2020-04-08 · Dear Precious Moments Family, Such excitement and joy fills our hearts upon sending this invitation to you! Please join

Add Event Extras (not already included in Full Packet Registrations) below.

Confirm Add-On Paid Class selections below.

Total Packets $ Total Extras $ Total Paid Classes $

DESCRIPTION

QUANTITY

AMOUNT DUE Received by 5/29/2020

AMOUNT DUE Received 5/29/2020 – 8/1/2020

TOTAL

EVENT EXTRAS

EVENT T-SHIRT ( ADULT SIZE S-XL)

X $20.00 EACH NOT AVAILABLE $

EVENT T-SHIRT (ADULT SIZE 2XL – 5XL)

X $25.00 EACH NOT AVAILABLE $

EVENT T-SHIRT (YOUTH SIZES XS – L)

X $18.00 EACH NOT AVAILABLE $

EVENT PIN

X $10.00 EACH NOT AVAILABLE $

EVENT TOTE BAG

X $10.00 EACH NOT AVAILABLE $

ADD-ON PAID CLASSES*

MAKE-A-DOLL CLASS*

X $70.00 EACH $70.00 EACH $

CRAFTY WORKSHOP* (Minimum 40 participants required)

X $50.00 EACH $50.00 EACH $

*All paid classes are limited to available space. First registered, first served. ǂTo be guaranteed Event benefits, registration and payment MUST be received by Precious Moments Foundation by May 29, 2020. Space, seating, and other goodies are limited. Event t-shirt and other select items will not be available for registrants after May 29. Remaining items, if any, will be available for purchase in the Gift Shoppe beginning Friday, September 25, while supplies last.

GRAND TOTAL: $

Page 14: Precious Moments - September 23-25, 2020 · 2020-04-08 · Dear Precious Moments Family, Such excitement and joy fills our hearts upon sending this invitation to you! Please join

PAYMENT FORM To be guaranteed Event benefits, registration and payment MUST be received by Precious Moments Foundation by May 29, 2020. Space, seating and other goodies are limited. Event t-shirt and other select items will not be available for registrants after May 29. Remaining items, if any, will be available for purchase in the Gift Shoppe beginning Friday, September 25 while supplies last. Email completed Registration Form, Order Form, and Payment Form to [email protected]. Payment must be received in order for registration to be processed.

All fees are non-refundable. SEND REGISTRATION(S) AND FULL PAYMENT TO: Precious Moments Foundation

Attn: Reunion Event 2020

U.S. Mail: 4321 Chapel Road Fax: 417-359-2939 Carthage, Missouri 64836 U.S.A. Email: [email protected]

PAYMENT TOTAL $____________ Check: Check Number ________ Money Order: Money Order Number ________ Credit Card: Card Type: _______________________________________________________________ Credit Card Number: _______________________________________ Expiration Date: ______________ Security Code: ____________ Cardholder Name: ___________________________ (3 digits on back or 4 digits on front for American Express)

Cardholder Signature: _____________________________________________________________________________ (required for credit card remittance)

PAYMENT TOTAL $____________ Check: Check Number ________ Money Order: Money Order Number ________ Credit Card: Card Type: _______________________________________________________________ Credit Card Number: _______________________________________ Expiration Date: ______________ Security Code: ____________ Cardholder Name: ___________________________ (3 digits on back or 4 digits on front for American Express) Cardholder Signature: ______________________________________________________________________________ (required for credit card remittance) If more than two (2) forms of payment are being sent, please include this page for each form of payment submitted.

Payment total(s) must equal the Grand Total on the Price List & Order Form.

GRAND TOTAL: $